Adjusted treatment COMPArisons between guSelkumab and uStekinumab for treatment of moderate‐to‐severe plaque psoriasis: the COMPASS Analysis

BACKGROUND: Guselkumab is an interleukin-23 inhibitor indicated for the treatment of moderate-to-severe plaque psoriasis in adults. Guselkumab has demonstrated additional benefit in patients with early inadequate response to ustekinumab. Long-term efficacy comparisons of guselkumab and ustekinumab are currently lacking among ustekinumab-naive patients. OBJECTIVE: To assess the relative efficacy of guselkumab and ustekinumab for maintenance therapy of moderate-to-severe plaque psoriasis using individual patient data (IPD) from randomized controlled trials (RCTs). METHODS: IPD for guselkumab from the VOYAGE 1 and 2 trials were pooled and compared with IPD for ustekinumab from the NAVIGATE trial. Multivariable logistic regression analyses compared guselkumab 100 mg and ustekinumab 45/90 mg for the achievement and maintenance of Psoriasis Area and Severity Index (PASI) 90, 75, and 100 responses up to 40 weeks. The regression models accounted for a range of clinically relevant covariates (e.g., age, sex, psoriasis duration). Relative efficacy was expressed using odds ratios (ORs) and predicted probability of treatment response associated with each intervention. RESULTS: Patients receiving guselkumab had significantly higher probabilities of achieving a PASI 90 response compared with patients receiving ustekinumab at both week 16 (70.4% versus 46.0%; OR: 2.79, 95% CI 2.22-3.45) and week 40 (74.2% versus 54.5%; OR: 2.40, 95% CI 1.89-3.13). Compared to ustekinumab, guselkumab was also associated with a significantly increased likelihood of achieving both PASI 75 and PASI 100 responses at weeks 16 and 40. CONCLUSION: Adjusted analyses leveraging IPD demonstrates that guselkumab has a significantly higher probability of achieving and maintaining PASI treatment response through week 40 compared with ustekinumab.